Provider Demographics
NPI:1720702624
Name:BLAZONIS, ELAINE CECILE (RN)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:CECILE
Last Name:BLAZONIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 EMBANKMENT ST STE 2
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-4719
Mailing Address - Country:US
Mailing Address - Phone:978-687-6300
Mailing Address - Fax:978-682-4843
Practice Address - Street 1:10 EMBANKMENT ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-4731
Practice Address - Country:US
Practice Address - Phone:097-868-7630
Practice Address - Fax:978-682-4843
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN230318163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse